Active NPI
Lisa C Overton
- Podiatrist
- Philadelphia, PA
National Provider Identifier
1356397913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- SC004492L
- Legal business name
- LISA C OVERTON
- Practice address
- 1940 E Walnut LN
Philadelphia, PA 19138-1312 - Phone
- (215) 548-2113
- Fax
- (215) 548-3009
- NPI assigned
- May 25, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Lisa Carol Overton, D.P.M.
- Title
- Podiatrist
- Phone
- (215) 548-2010
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | SC004492L | PA | Primary |
Addresses
Primary practice location
1940 E Walnut LN
Philadelphia, PA 19138-1312
Mailing address
1940 E Walnut LN
Philadelphia, PA 19138-1312
Phone (215) 548-2113
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2134337000 | Other | PA | 10 DIGIT IBC HMO ID |
| 10741 | Other | PA | ELDER HEALTH ID |
| 5403600001 | Other | PA | DMERC SUPPLIER ID |
| 001444333 | Other | PA | HIGH MARK BLUE SHIELD ID |
| 0018442730002 | Medicaid | PA | |
| P00041340 | Other | PA | MEDICARE RAILROAD ID |
National Provider Directory
National Provider DirectoryLocations
1940 E Walnut Ln
Philadelphia, PA 19138
Phone (215) 424-7099
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1314921600000",
"number": "1356397913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1940 E WALNUT LN",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191381312",
"telephone_number": "215-548-2113",
"fax_number": "215-548-3009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1940 E WALNUT LN",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191381312",
"telephone_number": "215-548-2113",
"fax_number": "215-548-3009"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LISA C OVERTON",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-25",
"last_updated": "2011-09-02",
"status": "A",
"authorized_official_last_name": "OVERTON",
"authorized_official_first_name": "LISA",
"authorized_official_middle_name": "CAROL",
"authorized_official_title_or_position": "PODIATRIST",
"authorized_official_telephone_number": "215-548-2010",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.P.M."
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist",
"state": "PA",
"license": "SC004492L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "10 DIGIT IBC HMO ID",
"identifier": "2134337000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ELDER HEALTH ID",
"identifier": "10741",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC SUPPLIER ID",
"identifier": "5403600001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGH MARK BLUE SHIELD ID",
"identifier": "001444333",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0018442730002",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD ID",
"identifier": "P00041340",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.